I’m getting hung up on this item in regard to our KB qc:
TRM.40130 Alterative Control Procedures Phase II
If the laboratory performs test procedures for which control materials are not commercially available, there are written procedures for an alternative mechanism to detect immediate errors and monitor test system performance over time. The performance of alternative control procedures must be recorded.
Note: “Performance” includes elements of accuracy, precision, and clinical discriminating power. Examples of alternative procedures may include split sample testing with another method or with another laboratory, the testing of previously tested patient specimens in duplicate, testing of patient specimens in duplicate, or other defined processes approved by the laboratory director.
Evidence of Compliance:
Written procedures for alternative quality control AND
Records of alternative control procedures
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Are most of you buying qc for Kleihauers? We are still making our own positives by diluting a normal adult CBC tube with cord cells (high and low positive controls) and of course using the normal adult as the negative control. We count patients in duplicate and the two counts must be within 10% of each other. Are we in compliance? Control materials are commercially available, we jut don't use them (yet anyway!). One other question, we have always said the number of fetal cells in the high positive control should be roughly twice the number in the low positive. If still making your own controls, do you all define 'roughly'?
Thanks so much in advance!
Cathy

Hello All,
An oncology nurse has asked if a smaller gauge needle could be used when transfusing patients where IV access is a major concern. Our current policy requires a 20 gauge needle or larger. She thinks using a smaller needle could possibly reduce the number of needle sticks difficult patients must endure and even possibly prevent the need for central line insertion. She sent me a 2016 article from Infusion Nurses Society that states when using a short peripheral catheter, use 20 to 24 gauge based on vein size and patient preference.
I reviewed the Technical Manual. It says acceptable intravenous catheter sizes for use in transfusing cellular blood components range from 22 to 14 gauge. A 20 to 18 gauge intravenous catheter is suitable for the general adult population and provides adequate flow rates without excessive discomfort to the patient. For infants and toddlers, a 24 to 22 gauge may be suitable but requires infusion through a syringe.
The only post I found on this site is approximately four years old. I am wondering what your policies are now. Does anyone allow smaller than 20 gauge?
Thanks very much,
Cathy

We are still having problems. We are on our 4th lot of gel cards and screening cells. These faint, weak positives are happening with panel cells as well as BioRad 3% cells diluted to 0.8%. What are you all doing? I don't want to revert back to tube but when we've tried every lot we have here - then what?
I can't even get through to technical service this morning

We have Oneg red cells tagged ahead of time with uncrossmatched tags and temperature indicators applied. That helps somewhat. We do an emergency release in the computer. I would hesitate to bypass the computer for safety reasons. I have my trainees practice it every day while in training. Good luck!
Cathy

Auntie-D, since the mom is Rh negative we do a type and dat on the baby to see if she needs additional RhIG. Excellent idea David thank you. I agree, it's probably academic only at this point. I thought about drawing the father but again, it probably will not alter treatment.

Hello Everyone, I need help please with some cord results on twins. Mom is O neg and displays anti-D, probably from her antenatal Rh immune globulin injection in March. No extraneous reactions on her panel. Twin A types group O. We are unable to determine the Rh as he types weak-D positive but also has a positive direct coombs. (Both 1+ in tube) We reported out his type as Undetermined. Twin B types O pos with a negative direct coombs. We repeated all testing, on lavender and the red tops received. We tried washing the cells additionally. I have anti-D reagent from Quotient and BioRad. Both gave the same results at immediate spin. I didn't repeat the weak-D testing since the DAT is positive. An eluate prepared from Twin A was all negative when tested with panel, A1 and B cells. I also ran additional cells looking for a low frequency antigen. I considered a mislabeled specimen but even if the samples were mixed up, we would still have the same results, just on the other twin. If the antigen sites were blocked because of the DAT, shouldn't we have been able to elute anti-D? What should we try next? Thanks in advance!

We use the same volumes as above. Positive control is Complement Check Cells diluted to 0.8%; negative control is a 0.8% screening cell. We let the card sit 5-10 minutes prior to spinning. If the AHG, IgG and complement reactions are all positive, we run a patient control in the buffer card. We require the positive and negative controls to be run with each complement test in the buffer card since we have to add the reagent in that card.

We order an e-xm in DOE and result in Result Entry as others do above. We print a xm tag and tag the unit. At the time of dispense, we print another copy of the xm tag. The only down side I can see when doing the electronic crossmatch in Dispense and Assign, is that we only get one tag. We like the two copies so one can stay attached to the unit during the entire transfusion and the two nurses doing the double check can sign the other and place on the chart. I like to hear ideas of others though!

I wish we didn't have one in the OR. We have had similar issues as above and put Safe-T-Vue indicators on every unit. We have an OR person take the temp, call it to us, and we record it daily. That way we know for sure it is documented consistently. We go up to change the chart weekly and also take care of the activations. Good luck!

Hi Everyone, I am so glad I found this thread. I am looking for guidance. We are debating what our policy should be regarding handling the tube again for an electronic crossmatch. We would like to NOT handle the tube again but cannot decide how we would type in the bb id, or where would we take it from, if not pulling the original sample. We result the bb id when resulting the type and screen, is this where you would get the id from? Thanks!

We test our cord bloods asap upon receipt so we can get the sample drawn for the fetal screen. After some education our L+D nurses try to get the cords down to us in a timely fashion. When a sample needs to be drawn for a fetal screen we have it drawn right away but do not necessarily test it stat.